Provider Demographics
NPI:1801294418
Name:FIREFIGHTER BEHAVIORAL HEALTH OF ILLINOIS LLC
Entity type:Organization
Organization Name:FIREFIGHTER BEHAVIORAL HEALTH OF ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GURA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-557-1267
Mailing Address - Street 1:1333 BURR RIDGE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6423
Mailing Address - Country:US
Mailing Address - Phone:815-557-1267
Mailing Address - Fax:
Practice Address - Street 1:1333 BURR RIDGE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6423
Practice Address - Country:US
Practice Address - Phone:815-557-1267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty